HomeMy WebLinkAboutCCF06182019_0006All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �ij�Il Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential__
PERMIT TYPE:
PROPOSED IMPROVEMENT LOCATION: —
Address: Uygy\ 01, jji&IV tLjo q ;fin ►���i/ �-1-(.�`� �.� 7
Property Tax ID #: N 56 Z.- (a - () \Zq - 00(9 � �D Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to be performed under this permit - check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric 'Plumbing _ Sprinklers _ Gener$tor _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
t
Cost of Construction: $ _ 4M Utilities: —Sewer Septic Building Height:
art Nj RArT0 )R
Name Mi
Address: O
City: t .n State�/1�
Zip Code: C 3Q 7 3 Fax:
Phone No. 31'1 1Jlq
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
Company:
Address: '
City: siul14�_ State:��
Zip Code: �ZH9g7 Fax: 177,-Z,rP%-D19�/
Phone No
E-Mail Aim 6
State or County License C",!�G
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
If value of HVAC is $7,500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
r,
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may
restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING
TWICE R IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF MMENCEMENT MUST BE RECORDED AND
POST N THE JOB SITE BEFORE THE FIRST INSPECTION. IF Y ,INTEN TO OBTAIN FINANCING, CONSULT
WITH R E DER AN ATTORNEY BEFORE RECORDING YOUR TICEMMENCEMENT."
Signatur f dwn L s /Contractor as Agent for Owner
Signature of ractor/ cen Holder
STATE OF FLORIDA /
STATE OF FLORIDA
COUNTY OFr�,?,
COUNTY OF g'.
;
The forgoing instrument was acknowledged before me
n
The forgoing instrument was acknowledged before me
this % day of 2%�by
this � day of ✓_�� 20�by g
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Name of person making statement.
Name of person making statement. d
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced 141
Produced
(Signature of NFE
Florida*DI LEMISCH
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(Signature of Notary Publi '. ,Flminit O public • State of Florida
otar Public - State of Florida
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NoCo�r�t�� s,ii�� GG 333310
yCprrhY. EStpires Jun 23, 2023
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Commission No.
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER
REVIEW
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COMPLETED
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Key.